title: Postpartum viral load rebound in HIV-1-infected women treated with highly active antiretroviral therapy: AIDS Clinical Trials Group Protocol A5150.
abstract: BACKGROUND
  Pregnancy may lead to increases in HIV-1 RNA levels postpartum. The AIDS Clinical Trials Group (ACTG) A5150 study was designed to characterize the incidence of viral load rebound during the immediate 24 weeks postpartum and explore factors associated with viral load rebound.
  
  
  METHODS
  We enrolled pregnant women in the United States who were ≥13 years of age, between 22 to 30 weeks gestation, and who planned to be on stable highly active antiretroviral therapy (HAART) for ≥8 weeks predelivery and to continue this therapy after delivery for the duration of the study. Choice of antiretrovirals (ARVs) was determined by the primary HIV provider. Viral load rebound was defined as an increase of ≥0.7 log10 (5-fold) from the average of the weeks 34 and 36 gestation viral loads to week 24 postpartum or an absolute increase to ≯500 copies/mL for those with viral load <50 copies/mL.
  
  
  RESULTS
  Eighty-four women enrolled for postpartum follow-up. Sixty-three had follow-up and viral load obtained through week 24 postpartum. Overall, 18/63 (28.6%; 95% confidence interval [CI], 17.9-41.4) met criteria for viral load rebound. Nineteen of the 63 women made changes or discontinued their ARV regimen prior to week 24 postpartum. For those who remained on stable ARVs, rebound occurred in 8/44 (18.2%; 95% CI, 8.2-32.7) compared with 10/19 (52.6%; 95% CI, 28.9-75.5) who did not remain on a stable ARV regimen.
  
  
  CONCLUSIONS
  In the early postpartum period, HIV-1-infected women commonly have increases in viral load. Unplanned changes in ARV regimens and discontinuations of treatment are frequent.
authors.affiliation: Section of Infectious Diseases, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Beverly E
authors.initials: BE
authors.lastname: Sha
authors.forename: Camlin
authors.initials: C
authors.lastname: Tierney
authors.forename: Susan E
authors.initials: SE
authors.lastname: Cohn
authors.forename: Xin
authors.initials: X
authors.lastname: Sun
authors.forename: Robert W
authors.initials: RW
authors.lastname: Coombs
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Frenkel
authors.forename: Spyros A
authors.initials: SA
authors.lastname: Kalams
authors.forename: Francesca T
authors.initials: FT
authors.lastname: Aweeka
authors.forename: Barbara
authors.initials: B
authors.lastname: Bastow
authors.forename: Arlene
authors.initials: A
authors.lastname: Bardeguez
authors.forename: Anne
authors.initials: A
authors.lastname: Kmack
authors.forename: Alice
authors.initials: A
authors.lastname: Stek
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy* / Q000821:virology*; D015497:HIV-1 / Q000235:genetics / Q000254:growth & development*; D006801:Humans; D007231:Infant, Newborn; D016015:Logistic Models; D010349:Patient Compliance; D049590:Postpartum Period; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000097:blood / Q000188:drug therapy* / Q000821:virology*; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood; D019562:Viral Load
chemical_list: D012367:RNA, Viral